Sarah A. Collier

Setting a public health research agenda for Down syndrome: Summary of a meeting sponsored by the Centers for Disease Control and Prevention and the National Down Syndrome Society†‡§

On November 8–9, 2007, a meeting entitled “Setting a Public Health Research Agenda for Down Syndrome” was held to review current knowledge, identify gaps, and develop priorities for future public health research related to Down syndrome. Participants included experts in clinical and molecular genetics, pediatrics, cardiology, psychiatry, psychology, neuroscience, epidemiology, and public health. Participants were asked to identify key public health research questions and discuss potential strategies that could be used to address those questions. The following were identified as priority areas for future public health research: identification of risk and preventive factors for physical health and cognitive outcomes, focusing on understanding the reasons for previously recognized disparities; improved understanding of comorbid conditions, including their prevalence, clinical variability, natural history, and optimal methods for their evaluation and treatment; better characterization of the natural history of cognition, language, and behavior; identification of mental health comorbidities and of risk and protective factors for their development; identification of strategies to improve enrollment in research studies; development of strategies for conveying up‐to‐date information to parents and health professionals; identification of interventions to improve cognition, language, mental health, and behavior; understanding the impact of educational and social services and supports; identification of improved methods for diagnosis of and interventions for Alzheimer disease; and understanding the effects of different types of health care on outcomes. Participants strongly supported the development of population‐based resources for research studies and resources useful for longitudinal studies. This agenda will be used to guide future public health research on Down syndrome. Published 2008 Wiley‐Liss, Inc.

Prevalence of self-reported infection during pregnancy among control mothers in the National Birth Defects Prevention Study†

BACKGROUND Although specific maternal infections during pregnancy have been associated with birth defects and other adverse pregnancy outcomes, the prevalence of infections during pregnancy has not been well described. METHODS We estimated the prevalence of self-reported infection among 4967 women with live-born infants without major birth defects. We assessed the prevalence of reported infections and fever by type of infection, specific illness, and maternal characteristics including race and age. RESULTS Overall, 63.6% of women reported at least one infection during pregnancy. Reports of infections were more common during pregnancy than in the 3 months before pregnancy. Nearly half (49.6%) of women reported a respiratory infection, 20.5% reported a fever, 17.1% reported a urinary tract infection, 4.2% reported a yeast infection, and 3.4% reported a sexually transmitted disease. A subanalysis of self-reported infection and preterm delivery was performed among primiparous mothers with singleton pregnancies, but no statistically significant differences in infection prevalence were found. Women younger than 35 years reported nonrespiratory infections more frequently than women aged 35 years or older (prevalence ratio [PR] 1.41; 95% confidence interval [CI]: 1.21-1.64). Prevalence of nonrespiratory infections was also higher among those who smoked than among those who did not (PR 1.33; 95% CI: 1.20-1.47). CONCLUSIONS Reported infections during pregnancy are common, implying that a small increase in risk for birth defects or other adverse pregnancy outcomes could have a significant public health effect and underscoring the importance of understanding the effects of prenatal infections.

Maternal caffeine intake during pregnancy and orofacial clefts

BACKGROUND Moderate caffeine intake during pregnancy is common, but little is known about its potential association with birth defects. METHODS The National Birth Defects Prevention Study is a population-based, case-control study of major birth defects, excluding infants with single-gene disorders and chromosomal abnormalities. This analysis includes infants with cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO), excluding infants whose cleft was secondary to holoprosencephaly or amniotic band sequence. Mothers reported dietary caffeine intake from coffee, tea, sodas, and chocolate in the year before pregnancy and reported intake of medications containing caffeine during pregnancy. We assessed the association between dietary caffeine intake, frequency of consuming each type of caffeinated beverage, medications containing caffeine, and CL/P or CPO among infants born from October 1997 through December 2004. RESULTS This analysis included 1531 infants with CL/P, 813 infants with CPO, and 5711 infants with no major birth defects (controls). Examining dietary sources among control mothers, 11% reported consuming at least 300 mg of caffeine per day and 17% reported consuming less than 10 mg of caffeine per day; high consumption (>or=3 servings per day) was reported by 8% (coffee), 4% (tea), and 15% (sodas); medications containing at least 100 mg caffeine/dose were reported by less than 1%. Although some effect estimates were elevated for moderate caffeine intake from all beverages, estimates were closer to the null for high caffeine levels. Isolated CL/P was associated with use of medications containing at least 100 mg of caffeine per dose. CONCLUSIONS Our data do not suggest an association between maternal dietary caffeine intake and orofacial clefts, but caffeine-containing medications merit further study.

Economic and health impacts associated with a Salmonella Typhimurium drinking water outbreak-Alamosa, CO, 2008.

In 2008, a large Salmonella outbreak caused by contamination of the municipal drinking water supply occurred in Alamosa, Colorado. The objectives of this assessment were to determine the full economic costs associated with the outbreak and the long-term health impacts on the community of Alamosa. We conducted a postal survey of City of Alamosa (2008 population: 8,746) households and businesses, and conducted in-depth interviews with local, state, and nongovernmental agencies, and City of Alamosa healthcare facilities and schools to assess the economic and long-term health impacts of the outbreak. Twenty-one percent of household survey respondents (n = 369/1,732) reported diarrheal illness during the outbreak. Of those, 29% (n = 108) reported experiencing potential long-term health consequences. Most households (n = 699/771, 91%) reported municipal water as their main drinking water source at home before the outbreak; afterwards, only 30% (n = 233) drank unfiltered municipal tap water. The outbreak’s estimated total cost to residents and businesses of Alamosa using a Monte Carlo simulation model (10,000 iterations) was approximately

Effect of specimen storage conditions on newborn dried blood spots used to assess Toxoplasma gondii immunoglobulin M (IgM)

1.5 million dollars (range:

Swimming in the USA: beachgoer characteristics and health outcomes at US marine and freshwater beaches.

196,677–

Antimicrobial and Analgesic Prescribing Patterns for Acute Otitis Externa, 2004-2010

6,002,879), and rose to

Giardiasis and Subsequent Irritable Bowel Syndrome: A Longitudinal Cohort Study Using Health Insurance Data

2.6 million dollars (range:

Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995-2012.

1,123,471–

Community Laboratory Testing for Cryptosporidium: Multicenter Study Retesting Public Health Surveillance Stool Samples Positive for Cryptosporidium by Rapid Cartridge Assay with Direct Fluorescent Antibody Testing

7,792,973) with the inclusion of outbreak response costs to local, state and nongovernmental agencies and City of Alamosa healthcare facilities and schools. This investigation documents the significant economic and health impacts associated with waterborne disease outbreaks and highlights the potential for loss of trust in public water systems following such outbreaks.